IMPROVING Referring Physician Satisfaction · IMPROVING Referring Physician Satisfaction Maureen...
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©2014 MFMER | 3334978-1 IMPROVING Referring Physician Satisfaction Maureen O’Brien Pott Marlana Beck May 1, 2014
Transcript of IMPROVING Referring Physician Satisfaction · IMPROVING Referring Physician Satisfaction Maureen...
©2014 MFMER | 3334978-1
IMPROVINGReferring Physician Satisfaction
Maureen O’Brien Pott
Marlana Beck
May 1, 2014
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Key Takeaways
1. Physicians (and patients) rely on word-of-mouth when treatment of a complex condition is not available locally
2. A common understanding of results is critical to acceptance
3. Use internal comparison options for comparing results with limited external comparisons
4. Leverage all assets by clearly defining roles and responsibilities
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Mayo Clinic Florida
Mayo Clinic Arizona
Mayo Clinic Rochester
Mayo Clinic Locations
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Mayo Clinic’sHealth Care Relationship Continuum
Goodfriends
Owner-ship
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OSF Health Care
Palomar Health
Aspen ValleyHospital
St. FrancisHospital
BaptistHealth Care
WellStarHealth System
PikevilleMedical Center
Shriners HospitalsFor Children – Twin Cities
Médica Sur
ThedaCare
Trinity Health
BillingsClinic
Salus
NCH Healthcare
St. ElizabethHealthcare
SparrowHealth System
Dartmouth-Hitchcock
St.AlexiusMedical Center
Altru Health System
Yuma RegionalMedical Center
Kingman RegionalMedical Center
ASUHealth Services
HeartlandHealth
NorthShore UniversityHealthSystem
CentraCareCoborn Cancer Center
Yampa ValleyMedical Center
Mayo Clinic Florida
Mayo Clinic Arizona
Mayo Clinic Rochester
Mayo ClinicLocations
March 201426 Members
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Size and Scope
• Number of internal physicians ~4,000
• Unique physician referrals by site • Arizona 12,300
• Florida 27,800
• Minnesota 92,400
• Most referring physicians refer 1 patient to Mayo Clinic a year � a diverse set of referrers
• 1 million patients a year from all 50 states and 142 countries
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How This Works
• Physician led organization
• Physician – administrator partnerships
• Referring Physician Satisfaction roles and responsibilities
• Marketing – data stewards
• Referring Physician Office – data agents
• Clinical Practice Leadership – accountable for change
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Mayo Clinic
Who we are…Mayo Clinic Model of Care
Teamwork
Respect
Innovation
Culture
Quality
Scholarship
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4. “Be collegial and
supportive of
colleagues, master
teamwork skills and
acknowledge the
contributions of all.”
TEAMWORK in the MODEL OF CARE
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Positive Relationships with External Physicians Benefit…
Patients
•Coordinated care and better patient outcomes• Smooth transitions, effective referrals, and efficient communication between referring physicians andMayo physicians
• Physician – referred patients tend to have complex conditions and will benefitthe most from Mayo expertise
…and Mayo
• Significant portion of patient mix (~20%)
• External providers influence (positively or negatively) Mayo’s overall reputation
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Barriers to Makinga Referral to Mayo Clinic
• No personal contact at an organization
• Don’t know how to make a referral
• Location > patient convenience
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2013N=829
2011N=953
• MAJOR influence / VERY important
OR MINOR influence / SOMEWHAT
important
6.9 6.5
• MAJOR influence / VERY important 3.6 3.6
Patients Come to Mayo Without Referrals,
After Consulting Multiple Sources…
Average # of sources cited as:
Mayo Clinic 2013 New Patient Decision Making Study, n=829
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Of People Consulted, Family Members
have the Most Influence, but…
8%
9%
19%
17%
18%
53%
3%
2%
9%
15%
16%
17%
Mayo Clinic employee
Other person
Specialist you saw at home
Primary care doctor
Friend or co-worker
Spouse or family member
0% 20% 40% 60% 80% 100%
Major Influence Minor Influence
Totals
70%
34%
28%
11%
11%
32%
Q2. How much influence did the following people have in your decision to come to Mayo Clinic?
Mayo Clinic 2013 New Patient Decision Making Study, n=829
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.
External Physicians Influence Nearly HALF of all New Patients
19
17
30
9
15
17
- 20 40 60 80 100
Physician specialist
Primary care doctor
Any External MD
% Major Influence % Minor Influence
Q2: How much influence did the following people have in your
decision to come to Mayo Clinic?
Total: 47%
Mayo Clinic 2013 New Patient Decision Making Study, n=829Q2. How much influence did the following people have in your decision to come to Mayo Clinic?
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What are Referring Physicians Looking for When They Make Referrals?
If treatment of complex condition is not availablelocally, providers rely on:
• Recommendations from colleagues (word of mouth)
• Reputation of medical center, physician or specialty program
• Timely appointment access and communication aboutthe patient before, during and following care
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People don’t talk about good experiences, they talk about great experiences.
Remarkable doesn’t mean remarkable to you.It means remarkable to me.
Am I going to make a remark about it?
If not, then you’re average...
Seth Godin
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Survey History
Where We Were
• Small scale studies
• Specific service lines
• Campus specific, butnot comprehensive
Where We Are Now
• All Destination Practice campuses
• Robust sample sizes �service line level data
• On-going – quarterlyreports
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Trending Data Question: The referral process was easy.
Percent strongly agree
40 40 41
0
25
50
75
100
Quarter 1 Quarter 2 Quarter 3
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Survey Methodology
• Mailed survey, completed by paper or online
• Monthly sampling
• Robust sample size• AZ and FL Campuses – census
• MN Campus – random sample(oversampling for priority service lines)
• Response rate: ~15%
• Referrers surveyed only once/year, basedon first referral in a calendar year
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SurveyDesign����
Referral Variables� Referral requestor – MD, Nurse,
Referral Coordinator� Referral method – fax, phone, online� Appointment expectations� Date of referral – allows for trending
Referral Process� Process was easy� Knowledgeable and helpful appointment staff� Timely appointment received
Collaboration� Professional opinion respected� Timely feedback� Clear recommendations
Overall Assessment� Refer again� Recommend Mayo Clinic to a colleague� First choice referral center
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External Benchmarking –Not an option
• Mayo’s model of care � external comparisons are challenging
• Multi-specialty practice (an initial referral made to Pulmonary may result in thoracic surgery)
• Internally employed physicians + external referring physicians = different comparison base
• INSTEAD -- We use internal benchmarking and compare campuses and services lines
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Internal BenchmarkingQuestion: The referral process was easy.
Percent strongly agree
4641
46
0
25
50
75
100
AZ Digestive Diseases MN Digestive Diseases FL Digestive Diseases
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Open-ended Survey Responses Authenticate quantitative survey findings
Top Categories
• Provide prompt, helpful feedback
• Make the referral process quick and easy
• Offer timely appointments
Sample Comments
“Continue with current process. Feedback I received from surgeon and cardiologist was very good.I owe you many thanks.”
“Mayo is excellent – except we never receive anyfollow-up!”
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What did we find in our study?
• Referral method impacts satisfaction – fax, phone and online experiences differ
• Focus on care communication
• Improve ease and efficiency of referral process for referrers
• Campus and service line level data improve ability to identify best practices
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Word-of-mouth is a critical aspect of the referral decision
27
56
54
26
34
36
31
6
6
11
2
2
5
2
3
0% 20% 40% 60% 80% 100%
First Choice Referral Center
Refer to Mayo Clinic AgainWithout Hesitation
Recommend Mayo Clinic to aColleague
Strongly Agree Agree Neutral Disagree Strongly Disagree
Note: Data shown represents all responses from external referrers regarding Q1 & Q3 2013 experiences.
N=2,226
N=2,231
N=2,196
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We have the data…
So now what?
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Step 1: Coming to Consensus ����Reporting
• Response categories for analysis�Strongly agree
�Agree
�Neutral
�Disagree
�Strongly Disagree
• Sample size
• Relevant comparisons
% favorable
% unfavorable
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Strongly Agree Responses
All Respondents % Strongly Agree* n=
I would refer my patients to Mayo Clinic again without hesitation if medically indicated.
56 2,231
I would recommend Mayo Clinic to a colleague as a place to refer patients.
54 2,226
I believe the overall quality of care provided to my patient was excellent.
52 2,169
The person I spoke with to schedule the appointment was knowledgeable and helpful.
46 1,601
My professional opinion about my patient was respected. 45 2,121
I received clear recommendations for treating my patient. 41 2,138
The overall referral process was excellent. 41 2,193
The referral process was easy. 40 2,241
The overall process of transitioning care back to me was excellent. 39 2,093
I received timely feedback regarding my patient. 39 2,206
The patient received a timely appointment. 37 2,202
Mayo Clinic is my first choice referral center. 27 2,196
If needed, a Mayo Clinic physician was available in a timely manner for consultation prior to my referral.
21 1,138
Green = Highest; Red = Lowest
Base: Total Sample Responding
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Most and Least Favorable Responses
All Respondents % Favorable* n=
I would recommend Mayo Clinic to a colleague as a place to refer. 90 1,568
I would refer my patients to Mayo Clinic again without hesitation if medically indicated.
90 1,572
I believe the overall quality of care provided to my patient was excellent.
88 1,530
The person I spoke with to schedule the appointment was knowledgeable and helpful.
85 1,124
My professional opinion about my patient was respected. 84 1,501
The referral process was easy. 82 1,577
I received clear recommendations for treating my patient. 82 1,505
The overall process of transitioning care back to me was excellent. 81 1,479
The patient received a timely appointment. 80 1,554
The overall referral process was excellent. 80 1,552
I received timely feedback regarding my patient. 80 1,563
If needed, a Mayo Clinic physician was available in a timely manner for consultation prior to my referral.
55 813
Mayo Clinic is my first choice referral center. 53 1,548
*Includes Agree and Strongly Agree, Green = Highest; Red = Lowest
Base: Total Sample Responding
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Step 2: Coming to a Common Understanding
• Take time to achieve consensus on data standards• Data displays
• Interpretation
• Standards for taking action
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Step 2: Coming to a Common Understanding
• Identify requirements for an institutional response• What are the best practices for acting on data?
• What are the best practices for designing programs?
• Are roles and responsibilities clearly understood?
• Partnering with clinical leadership• Change agents
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Overcoming High-Level Barriers
• Ensure data are perceived as comparable for internal benchmarking
• Understand and develop the levers that move the processes and improve the services
• Take into account Mayo’s diverse referrer population and complexity/size/model of care
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Diffusing Results
• Enlist top leadership support
• Establish baseline measures
• Develop site and service line communication plan
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Next Steps- Internal
• Continue on-going data collection
• Track progress; regularly share results with sites and service lines
• Identify best practicesand work with service lineson improvement opportunities
• Maximize relationship between Referring Physician Office and Marketing
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Next Steps- External
• Automatic trigger process for timely correspondence
• Increase physician visibility
• Improve referral process
• Improve technical footprint
• Maximize office visit impact
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Questions?
